Provider Demographics
NPI:1639850357
Name:KANG, DAEUN
Entity Type:Individual
Prefix:
First Name:DAEUN
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAEUN
Other - Middle Name:
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3290 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8694
Mailing Address - Country:US
Mailing Address - Phone:231-881-9000
Mailing Address - Fax:
Practice Address - Street 1:3290 WOODS WAY
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8694
Practice Address - Country:US
Practice Address - Phone:231-881-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor